To report an initial single-centre experience with Onyx-18-only superior rectal artery embolisation for bleeding internal haemorrhoids, focusing on technical feasibility, treatment laterality, and updated clinical outcomes. Consecutive Onyx-only procedures performed between October 2023 and April 2026 in patients with bleeding-predominant internal haemorrhoids were retrospectively reviewed. Patients with portal hypertension/cirrhosis were excluded because of the distinct pathophysiology of anorectal bleeding. Patient-level clinical outcomes and procedure-level technical variables were analysed separately. Updated telephone follow-up was obtained on 12 August 2026. Six patients underwent 9 procedures. Technical success was achieved in all procedures. Three patients were treated bilaterally at the initial session and 3 initially unilaterally; 2 of the latter required staged contralateral embolisation. At updated follow-up, all 6 patients reported absence of rectal bleeding after completion of treatment. Median follow-up was 19.5 months (range, 4–34), and 5 of 6 patients had at least 12 months of follow-up. One transient episode of rectal pain occurred; no major or clinically evident ischaemic complication was observed. Onyx-only haemorrhoidal artery embolisation was technically feasible with encouraging updated bleeding control. The observed association between bilateral treatment and fewer staged procedures is hypothesis-generating and may partly reflect an operator learning curve.
Abstract Background The purpose of this study is to externally validate a published ratio of left adrenal aldosterone to calculated-right adrenal aldosterone (Aldosterone LAV :cAldosterone RAV ) proposed to determine disease subtype when right-sided adrenal vein sampling is unsuccessful. Materials and methods This single-center retrospective study included 199 post-adrenocorticotropic hormone stimulation adrenal vein sampling cases (2016–2025). A selectivity index ≥ 5 was considered diagnostic and lateralization index ≥ 4 indicated unilateral disease. The cAldosterone RAV was calculated as cAldosterone RAV = [2 × Aldosterone IVC × (Cortisol LAV /Cortisol IVC )]–Aldosterone LAV . The ratio of Aldosterone LAV :cAldosterone RAV determined disease subtype; published thresholds were ≥ 3 for left-sided and ≤ 0.33 for right-sided disease. Intermediate values were deemed bilateral disease. Sensitivities and specificities of this metric were calculated using standard AVS interpretation as the gold standard reference. Receiver operating characteristic curve analysis performed on the Aldosterone LAV :cAldosterone RAV ratio derived institution-optimized thresholds by maximizing the Youden’s J statistic. Results Adrenal vein sampling was technically successful with determinate lateralization indices in 164 patients (41 left, 35 right, 88 bilateral). Using the published thresholds of 3 and 0.33, the Aldosterone LAV :cAldosterone RAV ratio had an overall accuracy of 43.3% (95% CI 35.9–50.9%). Institution-optimized thresholds of ≥ 32.43 (left-sided) and ≤ 0.56 (right-sided) improved the accuracy to 65.9% (95% CI 58.3–72.7%). Using institution-optimized thresholds, the sensitivities/specificities for the calculated right-sided, left-sided, and bilateral disease were 88.6%/95.3%, 92.7%/63.4%, and 44.3%/93.4%, respectively. Conclusions The Aldosterone LAV :cAldosterone RAV ratio can help to rule in right-sided disease with high specificity, but otherwise has poor overall accuracy in disease subtyping, underscoring the importance of meticulous technique to achieve diagnostic samples during adrenal vein sampling.
Abstract Purpose To describe false lumen embolization with an endovascular adhesive repair concept, in which N-butyl cyanoacrylate is injected with the intention of promoting reapposition of the dissected layers while preserving the parent-artery. Materials and methods Three men aged 50, 55, and 68 years with spontaneous dissecting aneurysms of the celiac axis (two patients) or the right hepatic artery (one patient, with dissection extending from the common hepatic artery) were treated; one patient had segmental arterial mediolysis; in another, the gastroduodenal collateral pathway had been surgically interrupted by prior pancreaticoduodenectomy. Indications were aneurysm enlargement with persistent pain, progressive aneurysm enlargement, and concern for rupture during planned endoscopic treatment. A microcatheter was navigated into the false lumen under digital subtraction angiography, and a 33% N-butyl cyanoacrylate–iodized oil mixture was injected to embolize the false lumen and appose the intimal flap. In two patients, a silicone balloon catheter was used to limit N-butyl cyanoacrylate overflow into the true lumen; it was introduced through a separate femoral access in Case 1 and through the same guiding sheath as the microcatheter in Case 2. Technical and clinical success, parent-artery patency, complications, and recurrence were assessed. Results Evident inflow into the false lumen disappeared in all cases, with all parent-arteries preserved. There was no rupture, unintended non-target embolization, or catheter adhesion. Follow-up showed no recurrence, and patency was verified during clinically indicated vascular studies at 10.5, 6, and 4 years; in two patients the repaired segment again served as a catheterization route. Conclusion False lumen embolization with an endovascular adhesive repair concept was technically successful with parent-artery preservation in three highly selected patients, and patency was confirmed at 10.5, 6, and 4 years after treatment. Further investigation is required to determine the safety, reproducibility, and appropriate indications of this technique. Level of evidence Level 4, Case Series.
Abstract Objective To evaluate the long-term safety and efficacy of the pave-and-crack technique, combining aggressive balloon dilatation and covered stent implantation, for endovascular therapy (EVT) of highly calcified femoropopliteal chronic total occlusions (CTOs) in poor surgical candidates unsuitable for open revascularization or conventional EVT. Design Single-center retrospective cohort study based on a prospectively maintained peripheral artery disease database. Methods Patients with symptomatic femoropopliteal CTOs treated using the pave-and-crack technique between September 2014 and April 2025 were included. Lesion and procedural characteristics, technical success, defined as residual stenosis ≤ 30%, complications, major target limb amputation, and symptom status were assessed. Kaplan–Meier analysis was used to estimate freedom from target lesion revascularization (TLR) and all-cause mortality through 5 years. Results A total of 122 patients with 136 femoropopliteal CTOs were treated. Mean lesion length was 253.0 ± 90.1 mm, and 93.4% (127/136) of lesions were severely calcified. Retrograde access was required in 72.8% (99/136) of procedures. Technical success was achieved in 93.4% (127/136). Freedom from target lesion revascularization was 91.4% ± 2.6% at 1 year, 77.9% ± 4.6% at 3 years, and 66.7% ± 7.2% at 5 years. Major target limb amputation occurred in four cases presenting with CLTI (8.5%; 4/47) and none with claudication (0%; 0/89). Five-year freedom from all-cause mortality was 71.4 ± 6.9% for claudicants and 41.4 ± 11.2% for patients with CLTI ( p < 0.01). Conclusion The pave-and-crack technique is feasible for highly calcified femoropopliteal CTOs, achieving high technical success, encouraging long-term freedom from TLR, and high limb salvage. Graphical Abstract Long-Term Outcomes of the “Pave-and-Crack” Technique for Severely Calcified Femoropopliteal Chronic Total Occlusions. (Left) Lesion and Procedural Characteristics. (Middle) the “Pave-and-Crack” Technique (A) Fluoroscopy showing aggressive balloon pre-dilatation. (B) Angiography showing vessel rupture. (C) Fluoroscopy following covered stent implantation (Viabahn) and relining with an interwoven nitinol stent (Supera). (D) Final angiography. (Right) Kaplan Meier survival curves and estimates for freedom from target lesion revascularization over five years stratified for popliteal involvement (segment P1-P3). CLTI: Chronic limb threatening ischemia. CTO: Chronic total occlusion. PACSS: Peripheral Calcification Scoring System. PTA: Percutaneous transluminal angioplasty. KM: Kaplan-Meier, SD: Standard deviation, TLR: Target lesion revascularization.
Endovascular stenting is a preferred treatment approach for the management of pelvic congestion syndrome (PCS) secondary to nutcracker syndrome. However, there is no consensus on which stenting device is advantageous for patients. In this report, we summarize off-label use of the Wrapsody™ Cell-Impermeable Endoprosthesis (CIE) for this condition. A 30-year-old woman presented with chronic left flank and lower abdominal pain, progressively worsening since childbirth. Imaging demonstrated compression of the left renal vein between the aorta and superior mesenteric artery with reflux into the ovarian vein. Endovascular treatment was performed using a 14 × 40 mm CIE. The procedure was technically successful and symptomatic resolution was achieved without complications. Follow-up over 2 years confirmed persistent device patency and absence of venous congestion. This case highlights that the CIE, a device originally designed for restoration of hemodialysis access, is an effective endovascular option for managing PCS due to nutcracker syndrome.
Abstract Purpose This prospective, multicenter, single-arm clinical trial evaluated the safety and efficacy of the Jetstream Atherectomy System in 72 Chinese patients with calcified femoropopliteal artery occlusive disease (FPOAD). Materials and methods The study protocol was approved by the institutional review boards of all participating centers, and all participants provided written informed consent. The primary endpoints were 30-day major adverse events (MAE) and changes in angiographic stenosis. Secondary endpoints included vessel patency, clinical improvement, and adverse events during follow-up. Results The study cohort had a mean age of 67.5 ± 9.0 years, with a high prevalence of hypertension (79.2%) and diabetes (37.5%). Severe calcification (PACSS, Peripheral Arterial Calcium Scoring System, grade 3–4) was present in 43.1% of lesions. Technical success (≤ 30% residual stenosis) was achieved in 91.7% of cases. The 30-day major adverse events (MAE) rate was 1.4%, with one target lesion revascularization (TLR), and no deaths or amputations were recorded. Mean stenosis was reduced from 87.8 to 48.5%, with a mean lumen gain of 40.2%. At 12 months, primary patency was 68.4%; secondary patency was 89.7%. Clinical improvement was evidenced by an increase in the mean ankle-brachial index (ABI) from 0.52 ± 0.15 to 0.76 ± 0.18, and 91.7% (66/72) of patients showed an improvement of at least one Rutherford class after 1 year. Conclusions This study confirms the Jetstream system’s clinical value in Chinese FPOAD patients. Its combination of mechanical cutting and aspiration makes it particularly suitable for Asian-specific calcified lesions, achieving favorable clinical outcomes.
To report 36-month outcomes by anatomic and demographic subsets, and mortality through 60 months from the IN.PACT AV Access Study, a prospective, multicenter, randomized trial of a paclitaxel drug-coated balloon (DCB) versus percutaneous transluminal angioplasty (PTA) for dysfunctional hemodialysis arteriovenous fistulas (AVF). The IN.PACT AV Access Study enrolled 330 participants at 29 international sites and randomized 1:1 to DCB (n = 170) or PTA (n = 160). Target lesion primary patency (TLPP) outcomes through 36 months were stratified by core laboratory-adjudicated anatomic subsets: lesion types (de novo and restenotic), AVF type (radiocephalic and brachiocephalic/ brachiobasilic), and lesion locations (peri-anastomotic, cephalic arch, and venous outflow). TLPP outcomes were also stratified by participant demographics. Mortality rates were reported through 60 months. Through 36 months, DCB showed numerically or statistically greater TLPP compared to PTA in de novo (50.6 NCT03041467 . Registered 01 February 2017. Level 1b, Randomized controlled trial.
Abstract Objective To develop a patient-specific static and dynamic 3D-printing workflow for preoperative planning of endovascular repair in complex aortic disease with physician-modified stent grafts, to assess the respective roles of rigid anatomical and dynamic models, and to explore its association with intraoperative efficiency compared with conventional image-based planning. Methods This retrospective study included 46 consecutive patients with complex aortic disease encompassing various segments between the aortic arch and the abdominal aorta, who underwent endovascular repair with physician-modified stent grafts. Patients were assigned to a 3D printing-guided group ( n = 22) or a conventional image-guided group ( n = 24) based on the preoperative planning strategy. In the 3D printing group, patient-specific 1:1 rigid anatomical models and compliant dynamic models were generated from computed tomography angiography data. Rigid models were used for anatomical visualization, device sizing, and fenestration planning. Dynamic models, fabricated using silicone material (Shore hardness 10A) and integrated into a pulsatile flow system, were used to simulate device passage, deployment, and device–vessel interaction under physiological flow conditions. Model accuracy was evaluated by surface deviation analysis, and dynamic model performance was evaluated by Doppler-based flow comparison with in vivo measurements. The two groups were compared regarding operative time, radiation dose, contrast volume, perioperative complications, and short-term outcomes. Results Rigid anatomical models demonstrated high geometric fidelity, with over 97% of surface deviations within 0.2 mm compared with CTA data. Dynamic models showed close agreement with in vivo hemodynamics, with comparable peak systolic velocities at the inlet (1.48 ± 0.20 m/s vs. 1.52 ± 0.18 m/s, p = 0.274), aneurysmal segment (1.20 ± 0.18 m/s vs. 1.25 ± 0.15 m/s, p = 0.312), and outlet (1.35 ± 0.17 m/s vs. 1.38 ± 0.16 m/s, p = 0.401). In the 3D printing-guided group, simulation findings were concordant with intraoperative findings in 21 of 22 cases. Compared with rigid static models, dynamic models provided additional planning information in anatomically challenging cases, including severe angulation of arch or neck, severe luminal stenosis or true lumen collapse, target vessels arise from the aneurysm sac, complex target vessel proximal segment and severe access tortuosity. In the exploratory clinical comparison, the 3D-printing-guided group had significantly shorter operative time (133.6 ± 43.3 min vs. 171.4 ± 72.1 min, p = 0.039) and lower contrast volume (181.7 ± 68.6 mL vs. 234.9 ± 101.0 mL, p = 0.044) than the conventional image-guided group. The need for intraoperative device adjustment did not differ significantly between groups. No major adverse events occurred within 30 days in either group. Conclusion A patient-specific dual-model 3D printing workflow combining rigid anatomical models and dynamic models is feasible for planning endovascular repair of complex aortic disease with physician-modified stent grafts. The dynamic model provides complementary information beyond static anatomical assessment, particularly in anatomically complex cases requiring simulation of device–vessel interaction. The observed reductions in operative time and contrast use suggest potential intraoperative benefits.
Abstract Background Bleomycin Electrosclerotherapy (BEST) is an emerging treatment for slow-flow vascular malformations (SFVMs), utilising electroporation to enhance intralesional bleomycin uptake. This study evaluates the safety and clinical outcomes of BEST in reducing symptom severity (SS) and improving quality-of-life (QoL) in patients with SFVMs. Methods This retrospective, single-centre study analysed 20 consecutive patients with symptomatic SFVMs treated with BEST between September 2022 and November 2024. Patients underwent SS and QoL treatment specific questionnaires before treatment and at follow-up (mean: 286 days). Intralesional bleomycin injection was immediately followed by electroporation in every case. Results A total of 42 BEST procedures were performed, on the following anatomical areas: Face: 14 (70%), Neck: 2 (10%), Leg: 3 (15%), Arm: 1 (5%). Significant reduction in the mean SS (-8.2, p < 0.001) and QoL (-5.2, p < 0.001) scores was observed. The most improved domains were swelling (mean -2, p < 0.001), aesthetic concerns (mean -2, p < 0.001), and pain (mean -1.1, p < 0.003). No major complications were reported. Skin changes (needle marks) were reported in 13/20, and intra-oral ulcers occurred in 6/20 patients. Most skin changes were either fading away or resolved at follow up. All intra-oral ulcers resolved during follow up. Conclusions BEST is a safe procedure and demonstrates significant symptom relief and QoL enhancement, particularly in patients with severe baseline symptoms and more conspicuous lesions. While multiple treatments yielded greater improvements, even a single treatment was effective. Post-procedural side effects were minor, the most severe being skin markings and self-limiting ulceration.
Abstract Purpose To determine pulmonary arteriovenous malformation (PAVM) persistence and safety of high-volume detachable non-fibred (HVDNF) coil embolisation of de novo simple PAVMs using computed tomography pulmonary angiography (CTPA) at 6-month and 3-year follow-up. Methods This retrospective single-cohort study included patients who underwent embolisation of de novo simple PAVMs, exclusively with HVDNF coils, between January 2018 and January 2021. Primary endpoints were PAVM persistence at 6 months, cumulative persistence at 3 years and coil recanalisation at 6 months and 3 years. Secondary endpoints were technical success, safety, repeat embolisation and vein diameter reduction. Persistence and recanalisation were confirmed with digital subtraction angiography (DSA). Results This study included 50 patients with 75 de novo PAVMs. PAVM persistence at 6 months was 13.2%; cumulative persistence at 3 years was 17.4%. Coil recanalisation was the persistence mechanism in 10.3% of the cases at 6 months; at 3 years, this was 13.0%. Technical success rate was 98.7%. There were no procedure- or PAVM-related serious adverse events. Repeat embolisation with HVDNF coils was performed in 4 PAVMs after 6 months and 5 PAVMs after 3 years. Mean vein diameter reduction was 38.3% (SD 29.4%) at 6 months and 44.6% (SD 36.5%) at 3 years. Conclusions HVDNF coils are safe to use for de novo PAVM embolisation, show an excellent technical success rate and are associated with acceptable 6-month and 3-year persistence and coil recanalisation rates.
To evaluate the feasibility, short-term clinical outcomes, and technical considerations of transcatheter arterial embolization (TAE) for traumatic adrenal hemorrhage with contrast extravasation on CT. This single-center retrospective study included consecutive patients with traumatic adrenal hemorrhage showing contrast extravasation on CT who underwent TAE. Technical success was defined as complete embolization of the bleeding artery with no contrast extravasation on post-embolization angiography. Clinical success was defined as effective control of adrenal hemorrhage during the index hospitalization, as evidenced by the absence of repeat embolization or surgery and no clinical or imaging evidence of persistent or recurrent bleeding. Eight patients (4 men; median age, 78 years) underwent TAE. Adrenal hemorrhage was unilateral in all patients, involving the right side in 6 (75
Abstract Background To compare catheter directed thrombolysis (CDT) and endovascular mechanical thrombectomy (MT) for acute intermediate-risk and high-risk pulmonary embolism (PE) with respect to unplanned 6-month readmissions and in-hospital outcomes using a national database. Methods The NRD was queried from 2016 to 2022 for adult patients with acute nonseptic PE who received either CDT or MT. Inverse probability weighted regression adjustment was used to compare CDT and MT with regard to in-hospital mortality, unplanned 6-month readmissions, discharge other than home (DOTH), total cost as well as gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), blood transfusion at index admission, and 6-month readmission. Results are depicted as average treatment effect (ATE). Results A total of 28,376 patients were identified; 18,168 (64%) underwent CDT and 10,208 (36%) underwent MT. There was a total of 3,945 patients with high risk PE (13.9%). Compared to CDT, the ATE of MT was higher with regards to in-hospital mortality (ATE: 0.007; p = 0.048), DOTH (ATE: 0.031; p < 0.001), ICH (ATE: 0.006; p < 0.001), total cost at index admission (ATE: 0.118; p < 0.001), GIB at 6 months (ATE: 0.004; p = 0.023), blood transfusions at 6 months (ATE: 0.006; p = 0.017) as well as death at final follow-up (ATE: 0.009; p = 0.025). The ATE was similar between CDT and MT with regard to GIB ( p = 0.097) at index admission as well as unplanned 6-month readmission ( p = 0.10), ICH ( p = 0.11), and recurrent PE ( p = 0.39) at 6 months. Conclusion MT was associated with higher rates of mortality, DOTH, ICH, and total cost at index admission as well as GIB, blood transfusions, and mortality at 6 months. MT was associated with similar rates of GIB at index admission, as well as unplanned readmission, ICH, and recurrent PE at 6 months.
Abstract Background Refractory pain after knee arthroplasty without prosthetic loosening, infection, or mechanical failure remains a therapeutic challenge for which few non-surgical options are available. Genicular artery embolization (GAE) has shown promise in knee osteoarthritis, but evidence in patients treated after arthroplasty remains limited. The aim of this study was to evaluate the technical feasibility, safety, and short- to mid-term clinical outcomes of GAE using imipenem/cilastatin (IPM/CLS) in this population. Results Fifteen consecutive patients (9 men, 6 women; median age, 67 years) underwent GAE between January 2022 and December 2025 for refractory pain after total knee, unicompartmental, or isolated retropatellar arthroplasty. Hypervascular periarticular branches were embolized with an IPM/CLS suspension through common femoral arterial access. Outcomes were assessed using the Numeric Rating Scale (NRS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Total Analgesic Consumption Score (TACS) at baseline and 1, 3, 6, and 12 months. Technical success was 100%. Median NRS fell from 7.0 (interquartile range, 6.0–8.0) at baseline to 1.0 at 1 month ( p < 0.001), 3.0 at 3 and 6 months, and 5.0 at 12 months ( p = 0.018). Median WOMAC decreased from 32.0 to 20.0 ( p = 0.032) and KOOS from 20.0 to 14.0 ( p = 0.041) at 12 months. TACS improved significantly through 6 months ( p ≤ 0.026); 4 of 7 patients on baseline opioids had discontinued by 12 months. At 12 months, 5 of 9 evaluable patients (56%) maintained a ≥ 2-point NRS reduction and 4 of 9 (44%) achieved a ≥ 30% reduction. Repeat embolization was performed in 3 patients (20%). No major complications occurred; minor transient adverse events occurred in 2 patients (13%): mild periarticular discomfort and self-limited skin erythema. Conclusions In this small retrospective pilot cohort, GAE using IPM/CLS appeared technically feasible and safe and was associated with early pain reduction. Sustained clinically meaningful benefit at 12 months was limited to a subset of patients, indicating variable durability. These findings should be interpreted with caution and require confirmation in larger prospective studies.
The randomised SIRONA trial showed that sirolimus-coated balloon (SCB) angioplasty was non-inferior to paclitaxel-coated balloon angioplasty (PCB) regarding femoropopliteal primary patency. There was no difference in clinically driven target lesion revascularisation (cdTLR) rates between the treatment groups. This post-hoc analysis aimed to assess whether the overall results were consistent across different subgroups and selected post-baseline factors. Primary patency at 12 months was assessed using duplex ultrasound and adjudicated by a core laboratory for 203 and 199 participants in the SCB and PCB groups, respectively (available-case intention-to-treat analysis). Data on 12-month cdTLR were available for 238 and 244 participants in the SCB and PCB groups, respectively. Odds ratios (ORs) for primary patency and hazard ratios (HRs) for cdTLR after SCB compared to PCB in non-pre-specified subgroups were assessed using generalised linear mixed models to control for centre effects, and Cox proportional hazards models, respectively. Primary patency and cdTLR were generally consistent across the analysed subgroups. Two nominal interaction signals were observed. For cdTLR, a nominal interaction with age was identified (interaction p = 0.047); among participants older than 70 years, the estimated hazard ratio favoured SCB (HR 0.52, 95 https://clinicaltrials.gov/study/NCT4475783 .
Embolisation represents the primary therapeutic intervention for pulmonary arteriovenous malformations (PAVMs); however, post-procedural recanalisation remains a recognised complication. This study aimed to identify anatomical and morphological factors associated with PAVM recanalisation, while also describing embolisation modalities used. A retrospective, observational analysis was conducted on 40 patients with PAVMs embolised. Demographic variables, angiographic measurements (supplying artery, vein, sac diameters), embolisation modalities including coils, Amplatzer vascular plugs (AVPs), microvascular plugs (MVPs), or combinations, and the presence of recanalisation (defined as < 70
Abstract Background Outcomes with sirolimus-coated drug-eluting balloons (DEB) have been positive for the treatment of femoropopliteal arterial lesions but have not been studied in a broader patient population. Objectives Collect real-world safety and effectiveness data on the SELUTION SLR DEB in patients with claudication and chronic limb-threatening ischemia (CLTI). Methods This international multi-center, prospective, single-arm, post-market study (SUCCESS PTA) enrolled 723 patients at 27 sites. The primary endpoint was freedom from clinically driven target lesion revascularization (CD-TLR) after 1 year. Results Median age was 71.0 [63.0–79.0] years, 65% were male, 25.7% had CLTI. In total, 822 lesions were included; median lesion length was 100.0 mm [50.0–190.0] with 42.1% chronic total occlusions and 36.4% moderate-to-severe calcification. At 12 months, freedom from CD-TLR was 91.1%, 95% CI [88.6–93.1] and 52.1% of patients were asymptomatic. Median EQ-VAS score and ankle-brachial pressure index improved significantly from baseline to 12 months (65.0 [50.0–80.0] vs. 75.0 [60.0–85.0] ( p < 0.0001)) and (0.6 [0.5–0.8] vs. 0.9 [0.8–1.0] ( p < 0.0001)), respectively. At 12 months, outcomes in CLTI patients included major target limb amputation, 5.8%; major cardiac event rate, 4.3%; and death, 11.3%. Respective outcomes for those with claudication were 0.0%, 2.2% and 1.2%. Conclusions This real-world single-arm study is the largest assessment of a sirolimus DEB for treatment in claudication and CLTI. The outcomes were consistent with those reported for paclitaxel-coated balloons and support this DEB platform as a promising alternative, particularly in CLTI patients. Level of evidence Level 3.
To evaluate contrast-enhanced ultrasound (CEUS) for endoleak detection after endovascular aneurysm repair (EVAR) against CT angiography (CTA) or CTA-centered composite references, explicitly treating CTA as an imperfect reference standard. We searched PubMed/MEDLINE, Europe PMC, Crossref, OpenAlex, and performed an institutional Embase/Scopus coverage audit through 13 May 2026, with citation checking from prior reviews and included-study bibliographies. Eligible studies included adults undergoing paired CEUS and CTA or CTA-centered reference imaging after EVAR. The primary estimand was apparent CEUS diagnostic performance for any endoleak at the paired-examination level. An approximate bivariate logit-normal random-effects model was used as the primary meta-analysis; separate logit random-effects models, leave-one-out analysis, source-basis sensitivity analysis, and paired discordance testing were prespecified support analyses. Eighteen all-endoleak studies contributed 2064 participants and 2452 paired examinations. The bivariate model estimated CEUS sensitivity as 0.905 (95
